Fisher Kimberly A, Ahmad Sumera, Jackson Madeline, Mazor Kathleen M
Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA.
Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
Patient Educ Couns. 2016 Oct;99(10):1685-93. doi: 10.1016/j.pec.2016.03.027. Epub 2016 Mar 26.
To describe surrogate decision makers' (SDMs) perspectives on preventable breakdowns in care among critically ill patients.
We screened 70 SDMs of critically ill patients for those who identified a preventable breakdown in care, defined as an event where the SDM believes something "went wrong", that could have been prevented, and resulted in harm. In-depth interviews were conducted with SDMs who identified an eligible event.
32 of 70 participants (46%) identified at least one preventable breakdown in care, with a total of 75 discrete events. Types of breakdowns involved medical care (n=52), communication (n=59), and both (n=40). Four additional breakdowns were related to problems with SDM bedside access to the patient. Adverse consequences of breakdowns included physical harm, need for additional medical care, emotional distress, pain, suffering, loss of trust, life disruption, impaired decision making, and financial expense. 28 of 32 SDMs raised their concerns with clinicians, yet only 25% were satisfactorily addressed.
SDMs of critically ill patients frequently identify preventable breakdowns in care which result in harm.
An in-depth understanding of the types of events SDMs find problematic and the associated harms is an important step towards improving the safety and patient-centeredness of healthcare.
描述替代决策者（SDM）对重症患者可预防的护理失误的看法。
我们对70名重症患者的替代决策者进行筛查，找出那些认为存在可预防的护理失误的人，可预防的护理失误定义为替代决策者认为某件“出了问题”的事件，该事件本可预防并导致了伤害。对确定存在符合条件事件的替代决策者进行了深入访谈。
70名参与者中有32名（46%）确定了至少一次可预防的护理失误，共有75起不同的事件。失误类型包括医疗护理（n = 52）、沟通（n = 59）以及两者皆有（n = 40）。另外四起失误与替代决策者在床边接触患者时遇到的问题有关。失误的不良后果包括身体伤害、需要额外的医疗护理、情绪困扰、疼痛、痛苦、信任丧失、生活 disrupted、决策受损和经济费用。32名替代决策者中有28名向临床医生表达了他们的担忧，但只有25%得到了满意的解决。
重症患者的替代决策者经常发现导致伤害的可预防的护理失误。
深入了解替代决策者认为有问题的事件类型以及相关危害是提高医疗保健安全性和以患者为中心程度的重要一步。
